Living Arrangements and Intergenerational Support in Puerto Rico: Are Fathers Disadvantaged?

Role of intergenerational connections in cognitive aging: Evidence from a Chinese longitudinal study

Objective

To explore the impact of intergenerational connections on cognitive function in middle-aged and older adults (45-60 years and over 60 years, respectively) and analyze the urban-rural and sex differences in the effects of intergenerational connections on cognitive function.

Method

Based on China Health and Retirement Longitudinal Study data (CHARLS), this study conducted ID matching for four waves of data from 2011, 2013, 2015, and 2018. Cognitive function was measured via Telephone Interview for Cognitive Status-modified (TICS-m), word recall, and imitation drawing. Using a combination of cross-sectional and longitudinal research, we constructed the cross-lagged panel model (CLPM) with a sample of 1,480 participants to explore the relationship between intergenerational connections and cognitive function.

Results

This study examines the impact of intergenerational connections on cognitive function in middle-aged (45-60 years) and older adults (over 60 years) using data from the CHARLS. It identifies urban-rural and sex differences, with notable effects among rural female participants. The frequency of meeting with one child negatively predicts cognitive function (β = -0.040, p = 0.041), and the frequency of communication with one child positively predicts cognitive function (β = 0.102, 0.068, 0.041, p < 0.001, p = 0.001, 0.045). Meanwhile, intergenerational connections with multiple children positively predicts cognitive function (β = 0.044, p = 0.031), (β = 0.128, 0.084, and 0.056, p < 0.001, 0.001, p = 0.008). There are urban-rural and sex differences in the effects of intergenerational connections on cognitive function; additionally, the effects of intergenerational connections on cognitive function are significant in rural female middle-aged and older adults.

Discussion

This study proposes the theory of skewed intergenerational support, which suggests that as middle-aged and older adults age, the responsibility for intergenerational support is skewed toward one child. This leads to conflicts between middle-aged and older parents and the child, which further affects cognitive function. In addition, this study put forward the boat-carrying theory of intergenerational relations and "to hold a bowl of water level" is the art of dealing with intergenerational relationships.

Examining the impact of Co-residence with a daughter-in-law on older adult health in China: Evidence from a frailty index-based study

Background

The increasing geriatric population and variation in the disease spectrum among older adults in China contribute to a growing demand for more aged adult care in Chinese society. Relevant studies have shown that living arrangements with various family members have variable impacts on the older adult's health. This study employs the Frailty Index as a unified measurement standard to assess the overall health levels, integrating the specific "in-law relationships" into the research on living arrangements and the health of older adults.

Methods

This study used data from the China Longitudinal Aging Social Survey 2016-2018. OLS and Quantile Regression were used to investigate the in-law relationship on older adult health and whether this impact is homogeneous across older individuals with varying infirmity levels. The study used a lag model and propensity score matching to compensate for potential endogeneity concerns.

Results

The study found that residing with a daughter-in-law (20.22%) had a significant positive correlation with the frailty index (β=0.0088, P＜0.001), indicating that the relationship between parents-in-law and daughters-in-law can influence the health of the older adult. This impact is nonlinear and non-homogeneous for older adult people with various levels of frailty, exhibiting an approximately decreasing and then increasing U-shaped distribution, which denotes that older adult people with different health conditions have distinct demands for intergenerational care. In addition, this impact varies among older adult groups of disparate genders, urban and rural areas, and age groups.

Conclusion

This study investigates the impact of "in-law relationships" within living arrangements on the health of older adults. It shows that co-residing with a daughter-in-law has adverse effects on the health of older adults. Therefore, the study suggests that when the health and economic conditions of the elderly permit, a "live-near-but-not-with" living arrangement with their children can be considered.

Association between living arrangements and health risk behaviors among the Hakka older adults in Fujian, China

BACKGROUND

Behavioral lifestyles are important social determinants of health. The impact of changes in living arrangements on behavioral lifestyles is currently under-explored. This study aims to examine the association between living arrangements and health risk behaviors among the Hakka older adults.

METHODS

Data were extracted from China's Health-Related Quality of Life Survey for Older Adults 2018. Living arrangements were divided into five categories: living alone, living with spouse only, living with child, mixed habitation, and others. Five health risk behaviors, including unhealthy dietary patterns, drinking, smoking, irregular sleep practices, and physical inactivity were measured. Logistic regression analysis was used to assess the association between living arrangements and specific health risk behaviors, and generalized linear models were established to test the association between living arrangements and the number of health risk behaviors.

RESULTS

A total of 1,262 Hakka older adults were included in this study. Compared to those living alone, those living with spouse only were less likely to have unhealthy dietary patterns (OR = 0.45, P < 0.05) and drinking (OR = 0.50, P < 0.05), those living with the child were less likely to experience unhealthy dietary patterns (OR = 0.35, P < 0.001), drinking (OR = 0.32, P < 0.001), smoking (OR = 0.49, P < 0.05), and physical inactivity (OR = 0.13, P < 0.01). Moreover, those who were living with child (β = -0.78, P < 0.001) or mixed habitation (β = -0.33, P < 0.05) tended to engage in fewer health risk behaviors than those living alone.

CONCLUSIONS

This study suggests significant differences in health risk behaviors among the Hakka older adults with different living arrangements. Living with the child could reduce the occurrence of health risk behaviors in the Hakka older adults and thus maintain their health status.

Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002-2007

Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.

The neighborhood context and all-cause mortality among older adults in Puerto Rico

Background

Recent efforts have been made to collect data on neighborhood-level attributes and link them to longitudinal population-based surveys. These linked data have allowed researchers to assess the influence of neighborhood characteristics on the health of older adults in the US. However, these data exclude Puerto Rico. Because of significantly differing historical and political contexts, and widely ranging structural factors between the island and the mainland, it may not be appropriate to apply current knowledge on neighborhood health effects based on studies conducted in the US to Puerto Rico. Thus, we aim to (1) examine the types of neighborhood environments older Puerto Rican adults reside in and (2) explore the association between neighborhood environments and all-cause mortality.

Methods

We linked data from the 2000 US Census to the longitudinal Puerto Rican Elderly Health Conditions Project (PREHCO) with mortality follow-up through 2021 to examine the effects of the baseline neighborhood environment on all-cause mortality among 3,469 participants. Latent profile analysis, a model-based clustering technique, classified Puerto Rican neighborhoods based on 19 census block group indicators related to the neighborhood constructs of socioeconomic status, household composition, minority status, and housing and transportation. The associations between the latent classes and all-cause mortality were assessed using multilevel mixed-effects parametric survival models with a Weibull distribution.

Results

A five-class model was fit on 2,477 census block groups in Puerto Rico with varying patterns of social (dis)advantage. Our results show that older adults residing in neighborhoods classified as Urban High Deprivation and Urban High-Moderate Deprivation in Puerto Rico were at higher risk of death over the 19-year study period relative to the Urban Low Deprivation cluster, controlling for individual-level covariates.

Conclusions

Considering Puerto Rico's socio-structural reality, we recommend that policymakers, healthcare providers, and leaders across industries to (1) understand how individual health and mortality is embedded within larger social, cultural, structural, and historical contexts, and (2) make concerted efforts to reach out to residents living in disadvantaged community contexts to understand better what they need to successfully age in place in Puerto Rico.

Aging and the Left Behind: Puerto Rico and Its Unconventional Rapid Aging

Puerto Rico is aging more rapidly than almost any country, with 2020 estimates placing its population share of adults older than 65 as being the 10th highest in the world. Unlike most locales, Puerto Rico's aging is driven by both (a) the culmination of long-running fertility and mortality trends and (b) high levels of outmigration of working-age adults, which contributes both directly (removal of young people) and indirectly (reduced births) to its pace of population aging. This article offers an overview of the main issues surrounding population aging in Puerto Rico. Policymakers and government leaders must plan for Puerto Rico's unconventional population aging, which will exacerbate traditional concerns about the sustainability of government services and long-term economic prospects. Additional concerns emerge related to reduced social support networks and their impact on caregiving dynamics and implications for health. Puerto Rico's unique history and political relationship with the United States present challenges and benefits for its aging population. Research on aging in Puerto Rico and public health policies must adapt to the needs of the country's aging society.